Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oncology + Palliative > Palliative > Flashcards

Palliative Flashcards

1
Q

What is Cheynes Stoke breathing?

A

Progressively deeper breathing followed by gradual decrease = results in temporary apnoea Each cycle is 30s- 2 mins Oscillation of ventilation between apnoea + hyperpnoea with crescendo-diminuendo pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Non-opioid analgesics

A

Amitryptiline nocte

Baclofen

Dexamethasone od

Diazepam nocte

Diclofenac tds

Gabapentin mg

Ibuprofen tds

Naproxen bd

Pregabalin bd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Anti-emetic drugs

A

Cyclizine

Domperidone

Haloperidol nocte

Buscopan (hyoscine butylbromide)

Hyoscine hydrobromide

Levomepromazine

Metoclopramide (pre-meal)

Ondansetron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Laxative drugs + preparation

A

Co-danthrusate (capsules/ suspension) nocte

Docusate sodium (capsules)

Lactulose (solution)

Movicol (oral powder) 1 sachet bd

Senna (tablets/ syrup) nocte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SE of Levomepromazine in palliative care

A

Can be sedating + cause hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SE of hyoscine hydrobromide in palliative care

A

Can be sedating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SE metoclopramide, method of action + caution in what age group?

A

Can cause EPSEs

Caution in under 20 y/o

D2 antagonist 5HT4 agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What time to give steroids?

A

Best before 2pm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Main receptor sites for domperidone, cyclizine, hyoscine, haloperidol + levomepromazine

A

domperidone = D2 antagonist

cyclizine = H1 + Ach antagonist

hyoscine = Ach antagonist

haloperidol = d2 antagonist

levomepromazine = D2, H1, Ach + 5HT2 antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Action + indications for dexamethasone

A

Corticosteroid - agonist to glucocorticoid receptor

Indications: symptom control of anorexia, obstruction due to tumours, bronchospasm, partial obstruction, N+V adjunct, headaches due to raised ICP, pain due to nerve compression, cerebral oedema associated with malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Contraindications + SE of dexamethasone

A

CI: systemic infection, caution in DM due to raise in blood sugar.

SE: acne, blurred vision, bruising, HTN, weight gain, body hair, muscle weakness, swollen face, water retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Interactions + consequences of dexamethasone

A

Amiodarone, 1st gen AP, levopromazine, citalopram, clarithromycin, TCA, venlafaxine = torsades de point

Bleeding risk with NSAIDs

Increased digoxin activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are syringe drivers + how long do they last?

A

Sub cutaneous, usually over 24 hours, give a gradual infusion of meds CSCI - continuous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the anticipatory medicines + used for what?

A

Respiratory secretions = hyoscine butylbromide

Pain = opiates

Terminal agitation = midazolam

N+V = haloperidol, levomepromazine

Bowel colic = hyoscine butylbromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is terminal agitation?

A

Delirium with cognitive impairment

Common at end stage of cancer

S+S: agitation, myoclonic jerks, irritability, hallucinations, confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Action + indications of hycoscine butylbromide

A

Antimuscarinic antagonist - prevents action of Ach

Indications: relief of GI spasm, IBS, excessive resp secretions, bowel colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Contraindications of hycoscine butylbromide

A

Tachycardia GI obstruction/ ileus Glaucoma Prostatic enlargement

Myasthenia gravis Pyloric stenosis

Severe ulcerative colitis Significant bladder outflow obstruction toxic megacolon

Urinary retention Acute MI/ arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SE of hycoscine butylbromide

A

Anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is BiPAP used for?

A

2 pressure settings - prescribed pressure for inhalation + lower pressure for exhalation Used in sleep apnoea 2nd line to CPAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is CPAP used for?

A

Sleep apnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bone pain - S+S + treatment

A

Features: dull ache over large area or well localised tenderness over bone. Worse on weight bearing

Treat with NSAIDs, RT + bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Visceral pain S+S + treatment

A

Features = dull, deep seated, poorly localised pain. Can be spasmodic

Treatment = follow analgesic ladder.

Colic pain = give anticholinergic drugs eg hyoscine butylbromide for bowel colic, or oxybutynin for bladder spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Headache due to raised ICP - S+S + treatment

A

Features = dull, oppressive pain, worse on waking, coughing + sneezing

Treatment = corticosteroids to reduce oedema, NSAIDs + paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Neuropathic pain - S+S + treatment

A

Features = pain in area of abnormal sensation (numbness, sweating, burning)

Treatment = TCAs + anticonvulsants (gabapentin)

Nerve compression is helped by corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the analgesic ladder?
Step 1 = paracetamol Step 2 = weak opioid (Codeine) + paracetamol Step 3 = strong opioid NSAIDs at any stage Other adjuvant drugs: antiepileptics, antidepressants, corticosteroids
26
Strengths of co-codamol
8mg codeine 15mg codeine 30mg codeine All with 500mg paracetamol
27
Side effects of strong opioids + how to manage
Constipation = give laxative eg co-danthramer N+V = settles, provide antiemetic eg haloperidol Drowsiness = settles in 48 hrs Confusion/ hallucination = rare Resp depression = rare
28
S+S of opioid toxicity
N+V, drowsiness, confusion, visual hallucinations, myoclonic jerks, respiratory depression
29
Forms of oral morphine
Immediate release = 20-30 mins for effectiveness, lasts 4 hours (oramorph) Slow release = lasts 12 hours (morphine sulphate tablets)
30
Starting doses + titration of morphine
MST 20mg bd if been on max strength co-codamol Titrate up by 30-50%
31
Management of breakthrough pain
Should have 1/6th of total 24hr morphine dose as PRN = eg oramorph 10mg PRN
32
Diamorphine injection + dosing
SC as required or in syringe driver 3 times more potent than oral morphine Should be 1/3 of total oral morphine dose
33
What are transdermal analgesics?
Fentanyl or buprenorphine patches - duration of 72 hours. Suitable for pts with severe chronic pain already stabilised
34
What is oxycodone used for + what are the preparations?
Similar to morphine, 2nd line - good for renal impairment or if morphine not tolerated Immediate release = oxynorm Slow release = oxycontin
35
What are non-pharmacological treatments for pain?
RT (bone pain), chemo, surgery, anaesthetic interventions eg nerve block, CBT, TENS, aromatherapy etc
36
Mouth problems in palliative care + how to manage
Dry mouth (xerostomia) = due to reduced oral intake + SE of drugs (antiemetics, antidepressants, RT to head and neck) Oral thrush = treat with fluconazole or nystatin
37
Anorexia in palliative care - how to manage
Dexamethasone - wears off after 2-3 weeks Megestrol acetate - may cause fluid retention Present food nicely + offer small portions
38
What causes N+V in palliative care?
Stimulation of vomiting centre by 4 pathways: Gastric stasis/ irritation Toxic causes Cerebral causes Vestibular causes
39
Describe gastric stasis/ irritation - S+S, causes + treatment
Features: early satiety, fullness, heartburn. Due to tumour, hepatomegaly, ascites, dysmotility Treatment: metoclopramide before meals or SC over 24hrs. Consider PPI
40
Describe the S+S + toxic causes of N+V + how to manage
Features: nausea, small vomits, possets, retching Due to drugs (opioids, digoxin, antiepileptics), hypercalcaemia, uraemia, infections Treatment: haloperidol
41
Describe the cerebral causes of N+V - S+S + treatment
Raised ICP Features: early morning headache, vomiting, neurological signs Treatment: dexamethasone + cyclizine Anxiety: precipitated by certain situations Treatment: benzos, CBT Indeterminate - consider levomepromazine
42
Describe the vestibular causes of N+V - S+S + treatment
Features - associated with movement, hearing loss, vertigo or tinnitus Treatment: cyclizine, hyoscine, cinnarizine
43
Stool softener laxative use, SE
Lactulose + sodium docusate Causes bloating + flatulence
44
Stimulant laxative use, cautions
Senna, dantron Avoid in colic
45
Main laxative use in palliative care
Mixed softener + stimulant eg co-danthrusate (dantron + docusate) or Senna Good for opioid induced constipation
46
What are the features of intestinal obstruction in advanced cancer?
Frequently incomplete, intermittent + at multiple sites High incidence with bowel + ovarian cancer S+S: N+V, colicky pain, abdo distension, dull pain, diarrhoea/ constipation
47
Management of intestinal obstruction
Medication given by SC Antiemetics, analgesics, antispasmodics If colic is a feature, give stimulant laxatives Prokinetic drugs (metoclopramide) should be stopped Prescribe antispasmodics (hyoscine butylbromide)
48
Non pharmacological management of SOB
Breath training + relaxation O2 for acute episodes Fan on face
49
Pharmacological management of SOB
Opioids - low dose oral morphine Benzos - lorazepam or midazolam
50
Causes of cough in palliative care
Excessive production of fluid in lung (due to tumour), IFB, abnormal stimulation of airway receptors
51
Management of cough
Saline nebs if difficulty expectorating Linctus for dry + irritating cough Opioids as cough suppressants
52
What meds can be stopped when pt unable to swallow?
Vitamins/ iron Hormones Anticoagulants Corticosteroids Abx Antidepressants CV drugs Anticonvulsants used for pain
53
Management of terminal restlessness
Midazolam +- levomepromazine
54
How can the death rattle be managed?
Repositioning Antisecretory drugs eg hyoscine butylbromide/ hydrombromide
55
Indications for syringe drivers
Inability to swallow Persistent N+V Intestinal obstruction Malabsorption
56
What can be used for hiccups?
Chlorpromazine
57
What can be used to treat headaches caused by raised ICP?
Dexamethasone
58
What are the preferred opioids for patients with CKD?
Buprenorphine, alfentanil + fentanyl
59
How to convert codeine dose to morphine?
Divide by 10
60
Which laxatives are bulk forming?
Fybogel
61
Which laxatives are used to soften stools?
Lactulose Docusate
62
What are the stimulant laxatives?
Seena Bisodyl
63
Which laxatives are softeners + stimulants?
Movicol Macrogol Condanthrosate
64
Which anti-emetics cause constipation?
Ondansetron
65
What advice should be given with condranthramer?
Turns urine red/ orange
66
What are the NICE guidelines re laxatives?
Start with a stimulant eg Senna
67
What type of N+V should metoclopramide be used for?
Gastric causes eg stasis
68
How should N+V associated with raised ICP be treated?
Cyclizine + dexamethasone
69
How should anticipatory N+V be treated?
Lorazepam
70
How should N+V associated with renal failure be treated?
Haloperidol
71
What anti-emetic should be used for opioid associated nausea?
Haloperidol
72
How to manage pain (calculations of dose)?
Add up 24hr use of MST + oropmorph Convert to MST x2 (12hrly BD) Divide this dose by 6 = PRN dose
73
Opiate toxicity S+S
Constricted pupils Respiratory depression
74
What is GSF?
Gold Standard Framework 1) Identifies patients in last year of life 2) Assess needs 3) Plan for care
75
What drugs should be considered stopping, and stopped?
Consider: corticosteroids, hypoglycaemics, anticonvulsants Non essential: Antihypertensives, Antidepressants Laxatives, Anti ulcer drugs, Anticoagulants Long term antibiotics, Iron, Vitamins, Diuretics, Arrhythmics
76
What percentage of people get the following symptoms in their last day - death rattle, urinary dysfunction, pain, agitation?
Death rattle 56% Urinary dysfunction 53% Pain 51% Restlessness agitation 42%
77
What percentage of people get the following symptoms in their last day - SOB, N+V, sweating, jerking, confusion?
Breathlessness 22% Nausea and vomiting 14% Sweating 14% Jerking/plucking/twitching 12% Confusion 9%
78
How to work out diamorphine needs?
Divide total daily dose of morphine by 3 for 24 hour dose
79
How often does a syringe driver need changing?
Every 24hrs
80
What medicines aren't allowed in syringe drivers and why?
Chlorpromazine, diazepam, prochlorperazine Due to skin reactions
81
What to give for the symptom of SOB?
Oromorph or benzos
82
What can palliative RT be helpful in achieving?
Helps to control bleeding
83
When should chemo not be attempted?
In patients with low performance status or HF
84
What 2 drugs are likely to cause serotonin syndrome?
Tramadol + SSRIs
85
What does a burning feeling around ribs/ skin during chemo signify? How is it treated?
Shingles - treat with amitryptiline
86
Which anti-emetics work centrally + peripherally on dopamine receptors?
Metaclopramide = central D2 Domperidone = peripheral
87
When is metoclopramide CI?
Parkinsons + bowel obstruction
88
Palliative pt with renal failure - what meds should you change/ stop?
DAMN - diuretics, ACEi, metformin, NSAIDs - STOP Switch morphine to oxycodone
89
What commonly causes gastric stasis?
Liver mets

Oncology + Palliative (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions